Journal articles: 'Public health, Challenges, Uganda'

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Bosco Kakooza, John, Immaculate Tusiime, Hojops Odoch, and Vincent Bagire. "Management Practices and Performance of Public hospitals in Uganda." International Journal of Management Science and Business Administration 1, no. 7 (2015): 22–29. http://dx.doi.org/10.18775/ijmsba.1849-5664-5419.2014.17.1002.

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The Daily Monitor publications ran serialized articles showing the awful state of government hospitals across the country. While the Ministry of Health insists that the problem is not as bad as it is depicted, the level of service delivery in public hospitals has come under serious public scrutiny espousing the cause for concern about policy, practice and research. There should be glaring gaps in management practices as a possible explanation. In this study, we investigated impact of management decision making, structure, processes, communication and management style on hospital performance. The study has emphasized good management as the determinant of better performance of hospitals in the Ugandan context. Findings of this study challenges policy makers to strengthen management processes in addition to mobilizing financial, human and capital resources for hospitals. The study extends the debate on application of management theory with practice in the health sector in the Ugandan context.

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Mwesigwa, Catherine Lutalo, Brenda Akinyi Okumu, Charity Kirabo-Nagemi, Emma Ejuu, Estie Kruger, and Marc Tennant. "Mapping the geographic availability of public dental services in Uganda relative to ruralization and poverty of the population." Journal of Global Oral Health 2 (February 29, 2020): 86–92. http://dx.doi.org/10.25259/jgoh_66_2019.

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Objectives: Uganda is a low-income country faced with a number of challenges in health service delivery, including oral health services. Despite reports of an increased prevalence of oral diseases, they are afforded less priority, amidst competing priorities of infectious and other non-communicable diseases. Oral health-care services are offered free-of-charge in public health facilities. The majority of the Ugandan population live in rural areas. This would imply that public dental services should be more widely distributed in rural areas to meet the needs of the majority population. This study, therefore, aimed to determine the geographic distribution of public dental services relative to poverty and ruralization of the Ugandan population. Materials and Methods: All 112 districts in Uganda were to be surveyed for this study using an ecological design that incorporated the Ugandan population with socio-demographics obtained from the latest Uganda National Housing and Population Census and poverty data from the national Poverty Status Report 2014. The data from the districts were on the availability of public dental services and the physical location of these dental facilities. Overall, 182 public facilities were included in the study. The geographic location of public dental clinics was established using open-data sources. The data on ruralization were aggregated at the district level and that on poverty at the subregion level. Spatial analysis was done using geographic information science software, Quantum Geographic Information System. Results: The total Ugandan population was 34 million. Overall, 19.7% of the population was poor with the highest proportion located in the North and East of Uganda. Urban-rural characteristics varied across the country. Information on the 182 public dental clinics was collected from 97 of the 112 Ugandan districts. Among the 97 districts, 15% had no public clinic and were located in the poorest Ugandan regions. Among the 40 districts containing over 90% of the rural population, 20% had none, and 55% only had one dental clinic. In general, service availability reduced as the proportion of the rural and poor population increased. Conclusion: The spatial analysis presents an avenue to inform and guide the decision making and planning process by identifying geographic areas with access gaps relative to population socio-demographic characteristics. This study revealed that public dental services were least available for the poorest and rural populations, and yet they are already vulnerable to other access barriers. It is recommended that efforts should be made by health planners and policymakers to avert the health inequalities presented by inequitable access.

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Klabbers, Robin E., Timothy R. Muwonge, Emmanuel Ayikobua, Diego Izizinga, Ingrid V. Bassett, Andrew Kambugu, Alexander C. Tsai, Miranda Ravicz, Gonnie Klabbers, and Kelli N. O’Laughlin. "Health Worker Perspectives on Barriers and Facilitators of Assisted Partner Notification for HIV for Refugees and Ugandan Nationals: A Mixed Methods Study in West Nile Uganda." AIDS and Behavior 25, no. 10 (April 21, 2021): 3206–22. http://dx.doi.org/10.1007/s10461-021-03265-1.

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AbstractAssisted partner notification (APN) is recommended by the World Health Organization to notify sexual partners of HIV exposure. Since 2018, APN has been offered in Uganda to Ugandan nationals and refugees. Distinct challenges faced by individuals in refugee settlements may influence APN utilization and effectiveness. To explore APN barriers and facilitators, we extracted index client and sexual partner data from APN registers at 11 health centers providing care to refugees and Ugandan nationals in West Nile Uganda and conducted qualitative interviews with health workers (N = 32). Since APN started, 882 index clients participated in APN identifying 1126 sexual partners. Following notification, 95% (1025/1126) of partners tested for HIV; 22% (230/1025) were diagnosed with HIV with 14% (139/1025) of tested partners newly diagnosed. Fear of stigma and disclosure-related violence limit APN utilization and effectiveness. Prospective research involving index clients and sexual partners is needed to facilitate safe APN optimization in refugee settlements.

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Jeffer, Siya Balaam, Issmat I. Kassem, Samer A. Kharroubi, and Gumataw Kifle Abebe. "Analysis of Food Safety Management Systems in the Beef Meat Processing and Distribution Chain in Uganda." Foods 10, no. 10 (September 22, 2021): 2244. http://dx.doi.org/10.3390/foods10102244.

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Meat production is an essential component in food security and the economy in Uganda. However, food safety concerns pose a challenge to public health in Uganda and impede access to regional and global markets. Here, food safety management (FSM) practices in the Ugandan beef supply chain were evaluated. A cross-sectional survey was conducted in major slaughterhouses (n = 3), butcher shops (n = 184), and supermarkets (n = 25) in Uganda’s capital, Kampala. The three slaughterhouses had low scores in core control and assurance activities of FSM. Packaging interventions were weak in all the slaughterhouses, while only one slaughterhouse had a functional cooling facility. Supermarkets implemented better hygienic and preventative practices in comparison to butcher shops. However, both sourced from slaughterhouses that had low-to-poor hygiene practices, which weakened the efforts implemented in the supermarkets. Furthermore, most butcher shops did not offer training to meat handlers on HACCP (Hazard Analysis and Critical Control Point)-based practices. The low food safety performance in the supply chain was primarily attributed to poor sanitation, hygiene, and handling practices. Therefore, HACCP-based training and robust preventive, intervention, and monitoring systems are needed in the Ugandan beef supply chain to benefit public health and increase competitiveness.

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Atusingwize, Edwinah, Geofrey Musinguzi, Rawlance Ndejjo, Esther Buregyeya, Barbara Kayongo, Ruth Mubeezi, Richard K. Mugambe, et al. "Occupational safety and health regulations and implementation challenges in Uganda." Archives of Environmental & Occupational Health 74, no. 1-2 (September 17, 2018): 58–65. http://dx.doi.org/10.1080/19338244.2018.1492895.

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Feldmeier, Hermann, Osuke Komazawa, and Kazuhiko Moji. "Nodding Syndrome in Uganda: Field Observations, Challenges and Research Agenda." Tropical Medicine and Health 42, no. 2SUPPLEMENT (2014): S109—S114. http://dx.doi.org/10.2149/tmh.2014-s15.

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Batwala, Vincent, Pascal Magnussen, and Fred Nuwaha. "Challenges to implementation of artemisinin combination therapy policy in Uganda." International Health 2, no. 4 (December 2010): 262–68. http://dx.doi.org/10.1016/j.inhe.2010.07.002.

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Appiah, Bernard, Anubhuti Poudyal, David A. Anum, George Appiah, Andrew Christopher Wesuta, Kofi Akodwaa-Boadi, Ochieng’ Ogodo, Esther Nakkazi, Edgar M. Mulogo, and Samuel Nii Odai. "Challenges and facilitators of public engagement with water, sanitation, hygiene and other environmental health issues in Ghana and Uganda: perspectives of scientists, journalists and the public." Journal of Water, Sanitation and Hygiene for Development 10, no. 1 (December 12, 2019): 16–26. http://dx.doi.org/10.2166/washdev.2019.019.

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Abstract Despite many water, sanitation, hygiene (WASH) and other environmental health challenges in sub-Saharan Africa, little is known about interactions involving scientists, journalists and the public to aid public understanding of the relationship between WASH and health. Using purposive sampling, we conducted key informant interviews and focus group discussions with scientists, journalists and members of the public in Ghana and Uganda to identify issues associated with the promotion of public engagement with WASH and other environmental health issues. An inductive thematic analysis was used to explore the evidence, challenges and opportunities of public engagement. The effectiveness of public engagement was constrained by poor interactions between scientists and journalists and limited understanding among the public on WASH and other environmental health issues. Challenges identified included inadequate scientists–journalists collaborations, scientists' lack of time, pressure from media organizations and concerns about journalists' inadequate capacity to communicate environmental issues due to lack of training. Possible solutions included increased interactions, science communication training and using public information officers as knowledge brokers between scientists and journalists to boost public engagement with WASH and other environmental health issues. Our study contributes to the literature on the need to actively engage the public with WASH and other environmental health concerns.

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Gottschalk, Janet. "Womenʼs challenges: A report on the Vllth International Women and Health Meeting, Kampala, Uganda." Family & Community Health 17, no. 2 (July 1994): 38–44. http://dx.doi.org/10.1097/00003727-199407000-00008.

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Mukuru, Moses, Suzanne N. Kiwanuka, Linda Gibson, and Freddie Ssengooba. "Challenges in implementing emergency obstetric care (EmOC) policies: perspectives and behaviours of frontline health workers in Uganda." Health Policy and Planning 36, no. 3 (January 30, 2021): 260–72. http://dx.doi.org/10.1093/heapol/czab001.

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Abstract Uganda is among the sub-Saharan African Countries which continue to experience high preventable maternal mortality due to obstetric emergencies. Several Emergency Obstetric Care (EmOC) policies rolled out have never achieved their intended targets to date. To explore why upstream policy expectations were not achieved at the frontline during the MDG period, we examined the implementation of EmOC policies in Uganda by; exploring the barriers frontline implementers of EmOC policies faced, their coping behaviours and the consequences for maternal health. We conducted a retrospective exploratory qualitative study between March and June 2019 in Luwero, Iganga and Masindi districts selected based on differences in maternal mortality. Data were collected using 8 in-depth interviews with doctors and 17 midwives who provided EmOC services in Uganda’s public health facilities during the MDG period. We reviewed two national maternal health policy documents and interviewed two Ministry of Health Officials on referral by participants. Data analysis was guided by the theory of Street-Level Bureaucracy (SLB). Implementation of EmOC was affected by the incompatibility of policies with implementation systems. Street-level bureaucrats were expected to offer to their continuously increasing clients, sometimes presenting late, ideal EmOC services using an incomplete and unreliable package of inputs, supplies, inadequate workforce size and skills mix. To continue performing their duties and prevent services from total collapse, frontline implementers’ coping behaviours oftentimes involved improvization leading to delivery of incomplete and inconsistent EmOC service packages. This resulted in unresponsive EmOC services with mothers receiving inadequate interventions sometimes after major delays across different levels of care. We suggest that SLB theory can be enriched by reflecting on the consequences of the coping behaviours of street-level bureaucrats. Future reforms should align policies to implementation contexts and resources for optimal results.

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Nabukeera, Madinah. "The impact of the Country’s health services’ expenditure on the success of MDGs, Goal 4/SDG 3: Reduction of child mortality in Uganda (2000-2016)." Archives of Business Research 8, no. 8 (August 17, 2020): 69–82. http://dx.doi.org/10.14738/abr.88.8858.

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Safeguarding access to health services is a serious challenge for poor countries if the Sustainable Development Goals are to (SDGs) are to be achieved. This paper scrutinizes the case of Uganda, a country which is trying to improve its health sector amid a lot of challenges between 2000-2016 to assess how the country has performed in the reduction of child mortality given its expenditure. This study involved analyzing the available data drawn from various sources i.e., time series data on public health expenditure was obtained from Ministry of Health reports and the budget and Ministerial Policy Statements for the period 2000-2016. This data was further demarcated into parameters such as per capita government spending on health in Uganda shillings, health spending as a proportion of Gross Democratic Product (GDP) and private health spending as a proportion of total health spending. Findings revealed that non-significant negative effect of GDP per capita growth on infant mortality rate from 2000 to 2016, a negative effect of GDP per capita on under-five mortality in Uganda from 2000 to 2016, albeit the effect is non-significant (P>0.05), decline in Maternal Mortality Rate (MMR) from 527 death per 100,000 live birth in 1995 to 336 death per 100,000 live birth in 2016, and there is a negative but insignificant effect of health sector budget allocation on the MMR in Uganda since the P-value (0.199). Maternal mortality fell significantly in Uganda due to some interventions in the health sector. The decline is likely to have been cause due to supply and demand situations. There is need to improve funding in the health sector in order to improve quality health services through better coordination, health management, transportation, access, infrastructure at the district level.

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Akello, Grace, and Ulrike Beisel. "Challenges, Distrust, and Understanding: Employing Communicative Action in Improving Trust in a Public Medical Sector in Uganda." SAGE Open 9, no. 4 (July 2019): 215824401989370. http://dx.doi.org/10.1177/2158244019893705.

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We assessed how the everyday work challenges that frontline health workers (FRHWs) face in the government health sector in northern Uganda influence their trust in the Ministry of Health (MOH). We employed qualitative research techniques, including interviews and participant observation, over a 9-month period to examine FRHWs’ viewpoints about how the MOH should address these challenges in service delivery. One hundred and sixty-five FRHWs, of whom 48 were recruited for extensive follow-up, participated in our study. Key findings include distrust in the MOH is prevalent among FRHWs, there is a lack of trust in the organization’s coordination role in service delivery and this affects health care delivery to patients, interrelations, and provider cooperation. Therefore, restoring trust in government hospitals will require a truthful non-violent response by the MOH in its contractual agreement with FRHWs. In our analysis, we employ Habermas’s Theory of Communicative Action.

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Kiggundu, Amin Tamale. "Constraints to Urban Planning and Management of Secondary Towns in Uganda." Indonesian Journal of Geography 46, no. 1 (June 30, 2014): 12. http://dx.doi.org/10.22146/ijg.4986.

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Many towns in Uganda are growing at an unprecedented rate. By 2030 more than 50% of Ugandans will beliving in urban centres. This rapid growth of urban centres in Uganda provides for economic opportunities for manyurban residents. It also poses various challenges such as urban sprawl, emergence of informal settlements as well asurban poverty. Over 60% of the urban residents in Uganda live in the informal settlements with no basic services andinfrastructure such as piped water, decent housing, good roads, sewerage systems as well as schools and health centres.This paper aims to examine and understand the constraints to urban planning and management of secondary towns inUganda. Using an eclectic mix of research methods such as face to face interviews targeting key informants, a questionnairesurvey as well as observation, the study found that the current modernist planning approach has not achieved itsintended goal of promoting orderly urban development and improve service delivery in the secondary towns. The studyalso revealed that the urban residents are rarely involved in planning. Besides, there is an apparent mismatch betweenwhat is taught at the local planning schools and what is required in terms of planning in the secondary towns. To addressthese intractable urban challenges, it is critical that the current planning education and curriculum are reviewed to producecreative and imaginative planners that can respond more effectively to the community problems, adopt a strategyto promote strategic spatial planning that is more participatory, carry out public awareness campaigns about the need forproper planning of towns and adopt a strategy for promoting innovative funding programmes such as municipal bonds,use of the stock exchange to mobilise the required investable funds, allow the private sector to access institutional fundssuch as the employee provident fund and promote public-private partnerships.

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Hamill, Matthew M., Kimeze J. Mbazira, Agnes N. Kiragga, Charlotte A. Gaydos, Mary Jett-Goheen, Rosalind Parkes-Ratanshi, Yukari C. Manabe, Edith Nakku-Joloba, and Anne Rompalo. "Challenges of Rapid Plasma Reagin Interpretation in Syphilis Screening in Uganda." Sexually Transmitted Diseases 45, no. 12 (December 2018): 829–33. http://dx.doi.org/10.1097/olq.0000000000000883.

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Sharma, Vikrant, Manisha Sharma, Divya Dhull, Yashika Sharma, Sulochana Kaushik, and Samander Kaushik. "Zika virus: an emerging challenge to public health worldwide." Canadian Journal of Microbiology 66, no. 2 (February 2020): 87–98. http://dx.doi.org/10.1139/cjm-2019-0331.

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Zika virus (ZIKV) is a mosquito-borne virus that was first isolated from Zika forest, Uganda, in 1947. Since its inception, major and minor outbreaks have been documented from several parts of world. Aedes spp. mosquitoes are the primary vectors of ZIKV, but the virus can also be transmitted through sexual practices, materno-fetal transmission, and blood transfusion. The clinical presentations of symptomatic ZIKV infections are similar to dengue and chikungunya, including fever, headache, arthralgia, retro-orbital pain, conjunctivitis, and rash. ZIKV often causes mild illness in the majority of cases, but in some instances, it is linked with congenital microcephaly and autoimmune disorders like Guillain–Barré syndrome. The recent Indian ZIKV outbreak suggests that the virus is circulating in the South East Asian region and may cause new outbreaks in future. At present, no specific vaccines or antivirals are available to treat ZIKV, so management and control of ZIKV infections rely mostly on preventive measures.

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Asasira, Justus, and Frank Ahimbisibwe. "Public-Private Partnership in Health Care and Its Impact on Health Outcomes: Evidence from Ruharo Mission Hospital in Uganda." International Journal of Social Science Studies 6, no. 12 (December 27, 2018): 79. http://dx.doi.org/10.11114/ijsss.v6i12.3911.

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Background: Uganda’s government has embraced private provision of social services including health care. The involvement of private providers is an indicator that the public facilities are not sufficient enough to meet the high demands of the ever-increasing population. This has been done through partnership arrangements. This paper discusses the impact of Public-Private Partnership (PPP) in health care outcomes of the local population and opportunities for improving health outcomes, challenges facing private providers in a low income setting.Methodology: Data were collected using qualitative methods in January 2017 through interview (using semi-structured questions) at Ruharo Mission Hospital (RMH) administration, health workers, district health office and used a structured questionnaire for patients/clients. This was a nascent study, with a sample size of 22 respondents. The hospital has three departments; Organized Useful Rehabilitation Services (OURS), General Medical Services (GMS) and Eye Department (ED). All the departments of the hospital were represented in this study.Results: The hospital is a Church of Uganda project and runs a budget of 5 billion shillings ($ 1,351,351.4) annually, had multiple sources of funding including PHC funding annually and that, health services were delivered adequately to clients. Much as some services were accessed at no costs, other services like eye treatment were found expensive on the side of clients. The hospital’s hybrid mode of delivering health services through outreaches and facility-based services was cherished, however it had no ambulance and relied only on a hospital van.Conclusions and Recommendations: Our study concluded that if private providers are supported under the partnership arrangement, they can adequately deliver services to the clients and decongest the public facilities. We recommend that the government devote funds to support the hospital through employing more sub-seconded staff, procuring medicines, and ambulances to enable it to subsidize services especially eye treatment and other services not supported under the partnership.

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Luyirika, E., and F. Kiyange. "A Regional Palliative Care Entity Working With a Host Government to Facilitate Exchange Visits From Across Africa to Improve Access to Controlled Medicines for Cancer Patients." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 164s. http://dx.doi.org/10.1200/jgo.18.17300.

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Background and context: The African Palliative Care Association (APCA) is a pan-African palliative care organization hosted in Uganda but supporting initiatives to integrate palliative care into national health systems across Africa. Uganda hosts one of the oldest cancer units in Africa and also reconstitutes its own oral liquid morphine to reduce barriers and cost of access to pain control for patients. Aim: The aim of this effort is to expose government officials and other NGOs from other African countries to best practices in oral morphine manufacture, distribution and access to controlled medicines for pain control in cancer and other conditions with a view to benchmark and establish similar or better systems. Strategy/Tactics: APCA working with its funders in consultation with the Ugandan Ministry of Health and Hospice Africa Uganda, facilitates other African ministries of health delegations to conduct study visits in Uganda to benchmark the oral morphine reconstitution, the supply chain mechanisms for its distribution to patients in both public and private hospitals and at home. Program/Policy process: APCA identifies countries with morphine access challenges and makes arrangements for key personnel in those countries in ministries of health, medicines control authority, central medicines stores and national palliative care associations where they exist to spend a study period in Uganda. While in Uganda, the delegations visit the oral morphine manufacturing facility, Hospice Africa Uganda, the Ministry of Health, national medical stores, National Drug Authority, joint medical stores and some of the palliative care providers and training facilities. Once the period with the various stakeholders in the country is completed, the visiting teams draw up plans for implementation and identify required technical assistance from APCA. The costing and sources of funding are identified including contribution from the government in need and then activities are implemented. Outcomes: As a result of this South-to-South approach, Uganda has hosted delegations from 14 African countries. At one instance, it involved the Minister Of Health from Swaziland heading a delegation to Uganda while others sent other high level delegates to the peer learning and bench marking. All these countries have taken steps to establish access to oral liquid morphine as well as policy and capacity building activities for their staff. Some of the countries like Malawi and Swaziland are already having morphine reconstitution and national palliative care policies while others such as Rwanda and Botswana are in the process of changing to the same system. Cancer and palliative care related activities are also being implemented in some of countries. Some countries have graduated to host others like Uganda does. What was learned: The South-to-South learning and bench marking visits are very practical in Africa and have triggered palliative care initiatives at national level.

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Akatukwasa, Cecilia, Francis Bajunirwe, Simpson Nuwamanya, Noel Kansime, Emmanuel Aheebwe, and Imelda K. Tamwesigire. "Integration of HIV-Sexual Reproductive Health Services for Young People and the Barriers at Public Health Facilities in Mbarara Municipality, Southwestern Uganda: A Qualitative Assessment." International Journal of Reproductive Medicine 2019 (April 10, 2019): 1–11. http://dx.doi.org/10.1155/2019/6725432.

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Background. Sexual and Reproductive Health (SRH) and HIV risk behaviors for young people are intertwined. This rationalizes the need for integration of HIV and SRH services within the health care system, especially in countries with high HIV burden. In this study, we explored the current status of HIV-SRH integration for young people and barriers of integration from different stakeholders at public health facilities in Mbarara Municipality, southwestern Uganda. Methods. We conducted an exploratory qualitative study at public health facilities in Mbarara district of southwestern Uganda. Data were collected among young people (n=48), health care providers (n=63), and key informants (n=11). We used in-depth interviews and focus group discussions to collect the data. Coding and analysis of qualitative data were done using Atlas.ti. Results. Overall there was no differentiation of HIV-SRH services between adults and young people. Integration of HIV-SRH services was reported at all facility levels; however, there was poor differentiation of services for the young persons and adults. Integrated HIV and SRH services for young people were acknowledged to improve access to information and risk perception, improve continuity of care, and reduce cost of services and would also lead to improved client-health worker relationships. The potential barriers to achieving HIV-SRH integration included individual provider characteristics like lack of training and attitudes, generic health system challenges like low staffing levels, poor infrastructure with lack of space and privacy to deliver these services. At the policy level vertical programing and unclear policies and guidelines were identified as challenges. Conclusion. Our study shows integration of HIV and SRH services exists in general but services for adults and young people are blended or poorly differentiated. Significant health system barriers need to be overcome to achieve differentiation of the services for young people and adults.

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O’Donovan, James, Andrew Thompson, Christina Stiles, Japheth A. Opintan, Ken Kabali, Ian Willis, Mwebe Edward Mutimba, et al. "Participatory approaches, local stakeholders and cultural relevance facilitate an impactful community-based project in Uganda." Health Promotion International 35, no. 6 (February 18, 2020): 1353–68. http://dx.doi.org/10.1093/heapro/daz127.

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Abstract Sanitation is a major global challenge that is often addressed at national and international levels, while community opinions and beliefs are neglected. To promote water, sanitation and hygiene (WASH) we organized a cross-cultural knowledge exchange workshop to assess participatory methods for engaging local stakeholders. The workshop included 22 participants from all sectors of society. Practical solutions to sanitation challenges were identified and later shared with a local community. Qualitative and quantitative analyses were used to assess impact and showed participatory methods were highly valued to encourage information sharing among widely varied stakeholders, and that video was a particularly successful approach when engaging with local communities. An 8-month follow-up survey of village members revealed excellent information recall, positive behaviour changes and a desire for future visits. Our evidence suggests that community-based participation helped identify solutions to WASH issues affecting rural communities in resource-poor settings. Engaging in a multicultural knowledge-share was particularly valuable as it enabled participants to recognize they have common challenges and allowed them to share low-cost solutions from their different communities. Our use of video was widely viewed as an ideal means of circulating findings, as it communicated information to people with a wide variety of community roles and to all age groups. Its relevance was increased by adopting a culturally appropriate context by involving local communities in workshop activities. We recommend that research in low- and middle-income countries should be mindful of the environmental context in which WASH is implemented, and encourage acceptance by engaging with communities through the use of varied participatory methods.

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Asiimwe, P., P. Ebusu, and D. Olodi. "World Cancer Day As a Platform for Advocacy, Stakeholder Mobilization and Awareness Creation: The Experience of Uganda Cancer Society." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 169s. http://dx.doi.org/10.1200/jgo.18.69800.

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Background: World Cancer Day (WCD) provides a platform to raise awareness. This year Uganda's commemoration was held at the Parliamentary grounds. Aim: To bring together Uganda's stakeholders through an inclusion approach to advocate for, share information and raise awareness on cancer while recognizing efforts made and appreciating challenges faced in the fight against the epidemic. Strategy: Partnership building was key. Partners involved were; Uganda Cancer Society (UCS), Uganda Cancer Institute (UCI), Ministry of Health, World Health Organization, media, Uganda Corporate League, interreligious council, Kampala Capital City Authority, Parliament of Uganda, Uganda Police and UCS member organizations. Program process: A committee was set up and a concept developed adopting the tri-process approach; “Before - During - After” for implementation of activities. Outcomes: The digital campaign was launched using the signs for change and the #WeCanICanUg. There was high media coverage; 3 major national stations Urban TV, NBS TV and NTV UG, one regional station-CGTN Africa, as well as online platforms such as; WHO Africa Web site, UICC World Cancer Day impact report, the Grape Vine, Chimp reports, and more than 5 YouTube media uploads as per our monitoring and surveillance efforts on reach and impact. The lighting of the Queen's way clock tower attracted many passersby and media coverage. In addition there was awareness creation in select churches (6) and mosques (2) on 4th and 2nd February respectively. The WCD ceremony was attended by over 400 guests and officiated by the Speaker of Parliament who doubled as chief walker. The 7.3 km match past attracted involvement of the community along the way. The Speaker called upon the government through Ministry of Health to inject more money into training of more cancer specialists to work on cancer patients. She also stated the need to have cancer services moved closer than just the regional centers but to every district referral hospital for cancer screening and cancer treatment. She pledged Parliament's unconditional support to work with civil society in the cancer fight. The Minister of Health committed to the full operationalization of regional cancer centers by 2019. She applauded the role of civil society through Uganda Cancer Society on the advocacy efforts stating that they had already started yielding good results . The event ended with the corporate league football competitions which were aimed at promoting healthy lifestyles through physical exercise. Notably was the match between the Parliamentary team and the UCI team. The winner was given a trophy marked WCD 2018. What was learned: The role of civil society through umbrella bodies like UCS plays a crucial role in cancer control as seen during through planning, mobilization, partnership building and execution of WCD activities. Creativity and innovation is key in generating stakeholder and public interest in cancer control activities like WCD.

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Vindevogel, Sofie, Maarten De Schryver, Eric Broekaert, and Ilse Derluyn. "Challenges Faced by Former Child Soldiers in the Aftermath of War in Uganda." Journal of Adolescent Health 52, no. 6 (June 2013): 757–64. http://dx.doi.org/10.1016/j.jadohealth.2012.11.014.

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Medley, Amy M., and Caitlin E. Kennedy. "Provider Challenges in Implementing Antenatal Provider-Initiated HIV Testing and Counseling Programs in Uganda." AIDS Education and Prevention 22, no. 2 (April 2010): 87–99. http://dx.doi.org/10.1521/aeap.2010.22.2.87.

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Bunnell, R. E., J. Nassozi, E. Marum, J. Mubangizi, S. Malamba, B. Dillon, J. Kalule, J. Bahizi, N. Musoke, and J. H. Mermin. "Living with discordance: knowledge, challenges, and prevention strategies of HIV-discordant couples in Uganda." AIDS Care 17, no. 8 (November 2005): 999–1012. http://dx.doi.org/10.1080/09540120500100718.

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Ndyomugyenyi, R., T. Lakwo, P. Habomugisha, and B. Male. "Progress towards the elimination of onchocerciasis as a public-health problem in Uganda: opportunities, challenges and the way forward." Annals of Tropical Medicine & Parasitology 101, no. 4 (June 2007): 323–33. http://dx.doi.org/10.1179/136485907x176355.

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Razavi, S. Donya, Lydia Kapiriri, Julia Abelson, and Michael Wilson. "Who is in and who is out? A qualitative analysis of stakeholder participation in priority setting for health in three districts in Uganda." Health Policy and Planning 34, no. 5 (June 1, 2019): 358–69. http://dx.doi.org/10.1093/heapol/czz049.

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Abstract Stakeholder participation is relevant in strengthening priority setting processes for health worldwide, since it allows for inclusion of alternative perspectives and values that can enhance the fairness, legitimacy and acceptability of decisions. Low-income countries operating within decentralized systems recognize the role played by sub-national administrative levels (such as districts) in healthcare priority setting. In Uganda, decentralization is a vehicle for facilitating stakeholder participation. Our objective was to examine district-level decision-makers’ perspectives on the participation of different stakeholders, including challenges related to their participation. We further sought to understand the leverages that allow these stakeholders to influence priority setting processes. We used an interpretive description methodology involving qualitative interviews. A total of 27 district-level decision-makers from three districts in Uganda were interviewed. Respondents identified the following stakeholder groups: politicians, technical experts, donors, non-governmental organizations (NGO)/civil society organizations (CSO), cultural and traditional leaders, and the public. Politicians, technical experts and donors are the principal contributors to district-level priority setting and the public is largely excluded. The main leverages for politicians were control over the district budget and support of their electorate. Expertise was a cross-cutting leverage for technical experts, donors and NGO/CSOs, while financial and technical resources were leverages for donors and NGO/CSOs. Cultural and traditional leaders’ leverages were cultural knowledge and influence over their followers. The public’s leverage was indirect and exerted through electoral power. Respondents made no mention of participation for vulnerable groups. The public, particularly vulnerable groups, are left out of the priority setting process for health at the district. Conflicting priorities, interests and values are the main challenges facing stakeholders engaged in district-level priority setting. Our findings have important implications for understanding how different stakeholder groups shape the prioritization process and whether representation can be an effective mechanism for participation in health-system priority setting.

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Mindry, Woldetsadik, Wanyenze, Beyeza-Kashesya, Finocchario-Kessler, Goggin, and Wagner. "Benefits and Challenges of Safer-Conception Counseling for HIV Serodiscordant Couples in Uganda." International Perspectives on Sexual and Reproductive Health 44, no. 1 (2018): 31. http://dx.doi.org/10.1363/44e5718.

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Kawooya, Michael G. "Training for Rural Radiology and Imaging in Sub-Saharan Africa: Addressing the Mismatch Between Services and Population." Journal of Clinical Imaging Science 2 (June 29, 2012): 37. http://dx.doi.org/10.4103/2156-7514.97747.

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The objectives of this review are to outline the needs, challenges, and training interventions for rural radiology (RR) training in Sub-Saharan Africa (SSA). Rural radiology may be defined as imaging requirements of the rural communities. In SSA, over 80% of the population is rural. The literature was reviewed to determine the need for imaging in rural Africa, the challenges, and training interventions. Up to 50% of the patients in the rural health facilities in Uganda may require imaging, largely ultrasound and plain radiography. In Uganda, imaging is performed, on an average, in 50% of the deserving patients in the urban areas, compared to 10–13 % in the rural areas. Imaging has been shown to increase the utilization of facility-based rural health services and to impact management decisions. The challenges in the rural areas are different from those in the urban areas. These are related to disease spectrum, human resource, and socio-economic, socio-cultural, infrastructural, and academic disparities. Countries in Sub-Saharan Africa, for which information on training intervention was available, included: Uganda, Kenya, Tanzania, Rwanda, Zambia, Ghana, Malawi, and Sudan. Favorable national policies had been instrumental in implementing these interventions. The interventions had been made by public, private-for-profit (PFP), private-not-for profit (PNFP), local, and international academic institutions, personal initiatives, and professional societies. Ultrasound and plain radiography were the main focus. Despite these efforts, there were still gross disparities in the RR services for SSA. In conclusion, there have been training interventions targeted toward RR in Africa. However, gross disparities in RR provision persist, requiring an effective policy, plus a more organized, focused, and sustainable approach, by the stakeholders.

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Meyer, Amanda J., Mari Armstrong-Hough, Diana Babirye, David Mark, Patricia Turimumahoro, Irene Ayakaka, Jessica E. Haberer, Achilles Katamba, and J. Lucian Davis. "Implementing mHealth Interventions in a Resource-Constrained Setting: Case Study From Uganda." JMIR mHealth and uHealth 8, no. 7 (July 13, 2020): e19552. http://dx.doi.org/10.2196/19552.

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Background Mobile health (mHealth) interventions are becoming more common in low-income countries. Existing research often overlooks implementation challenges associated with the design and technology requirements of mHealth interventions. Objective We aimed to characterize the challenges that we encountered in the implementation of a complex mHealth intervention in Uganda. Methods We customized a commercial mobile survey app to facilitate a two-arm household-randomized, controlled trial of home-based tuberculosis (TB) contact investigation. We incorporated digital fingerprinting for patient identification in both study arms and automated SMS messages in the intervention arm only. A local research team systematically documented challenges to implementation in biweekly site visit reports, project management reports, and minutes from biweekly conference calls. We then classified these challenges using the Consolidated Framework for Implementation Research (CFIR). Results We identified challenges in three principal CFIR domains: (1) intervention characteristics, (2) inner setting, and (3) characteristics of implementers. The adaptability of the app to the local setting was limited by software and hardware requirements. The complexity and logistics of implementing the intervention further hindered its adaptability. Study staff reported that community health workers (CHWs) were enthusiastic regarding the use of technology to enhance TB contact investigation during training and the initial phase of implementation. After experiencing technological failures, their trust in the technology declined along with their use of it. Finally, complex data structures impeded the development and execution of a data management plan that would allow for articulation of goals and provide timely feedback to study staff, CHWs, and participants. Conclusions mHealth technologies have the potential to make delivery of public health interventions more direct and efficient, but we found that a lack of adaptability, excessive complexity, loss of trust among end users, and a lack of effective feedback systems can undermine implementation, especially in low-resource settings where digital services have not yet proliferated. Implementers should anticipate and strive to avoid these barriers by investing in and adapting to local human and material resources, prioritizing feedback from end users, and optimizing data management and quality assurance procedures. Trial Registration Pan-African Clinical Trials Registration PACTR201509000877140; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=877

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Javadi, Dena, John Ssempebwa, John Bosco Isunju, Lucy Yevoo, Alberta Amu, Elizabeth Nabiwemba, Michaela Pfeiffer, Irene Agyepong, and Luc Severi. "Implementation research on sustainable electrification of rural primary care facilities in Ghana and Uganda." Health Policy and Planning 35, Supplement_2 (November 1, 2020): ii124—ii136. http://dx.doi.org/10.1093/heapol/czaa077.

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Abstract Access to energy is essential for resilient health systems; however, strengthening energy infrastructure in rural health facilities remains a challenge. In 2015–19, ‘Powering Healthcare’ deployed solar energy solutions to off-grid rural health facilities in Ghana and Uganda to improve the availability of maternal and child health services. To explore the links between health facility electrification and service availability and use, the World Health Organization (WHO), in partnership with Dodowa Health Research Centre and Makerere University School of Public Health, carried out an implementation research study. The objectives of this study were to (1) capture changes in service availability and readiness, (2) describe changes in community satisfaction and use and (3) examine the implementation factors of sustainable electrification that affect these changes. Data were collected through interviews with over 100 key informants, focus group discussions with over 800 community members and health facility assessment checklist adapted from the WHO’s Service Availability and Readiness Assessment tool. Implementation factors were organized using Normalization Process Theory constructs. The study found that access to energy is associated with increased availability of health services, access to communication technologies, appropriate storage of vaccines and medicines, enhanced health worker motivation and increased community satisfaction. Implementation factors associated with improved outcomes include stakeholder engagement activities to promote internalization, provision of materials and information to encourage participation, and establishment of relationships to support integration. Barriers to achieving outcomes are primarily health systems challenges—such as drug stockouts, lack of transportation and poor amenities—that continue to affect service availability, readiness and use, even where access to energy is available. However, through appropriate implementation and integration of sustainable electrification, strengthened energy infrastructure can be leveraged to catalyze investment in other components of functioning health systems. Improving access to energy in health facilities is, therefore, necessary but not sufficient for strengthening health systems.

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Taylor, Ben, Dominic Bukenya, Piet van Asten, Dorice Agol, Adam Pain, and Janet Seeley. "The impact of HIV on agricultural livelihoods in southern Uganda and the challenges of attribution." Tropical Medicine & International Health 16, no. 3 (December 3, 2010): 324–33. http://dx.doi.org/10.1111/j.1365-3156.2010.02703.x.

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Okoboi, Stephen, Adelline Twimukye, Oucul Lazarus, Barbara Castelnuovo, Collins Agaba, Muloni Immaculate, Mastula Nanfuka, Andrew Kambugu, and Rachel King. "Acceptability, perceived reliability and challenges associated with distributingHIVself‐test kits to youngMSMin Uganda: a qualitative study." Journal of the International AIDS Society 22, no. 3 (March 2019): e25269. http://dx.doi.org/10.1002/jia2.25269.

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Dongo, John Paul, Stephen M. Graham, Joseph Nsonga, Fred Wabwire-Mangen, Elizabeth Maleche-Obimbo, Ezekiel Mupere, Rodrigo Nyinoburyo, et al. "Implementation of an Effective Decentralised Programme for Detection, Treatment and Prevention of Tuberculosis in Children." Tropical Medicine and Infectious Disease 6, no. 3 (July 14, 2021): 131. http://dx.doi.org/10.3390/tropicalmed6030131.

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Childhood tuberculosis (TB) is consistently under-detected in most high-burden countries, including Uganda, especially in young children at high risk for severe disease and mortality. TB preventive treatment (TPT) for high-risk child contacts is also poorly implemented. The centralised concentration of services for child TB at the referral level is a major challenge in the prevention, detection and treatment of TB in children. In 2015, the DETECT Child TB Project was implemented in two districts of Uganda and involved decentralisation of healthcare services for child TB from tertiary to primary healthcare facilities, along with establishing linkages to support community-based household contact screening and management. The intervention resulted in improved case finding of child and adult TB cases, improved treatment outcomes for child TB and high uptake and completion of TPT for eligible child contacts. A detailed description of the development and implementation of this project is provided, along with findings from an external evaluation. The ongoing mentorship and practical support for health workers to deliver optimal services in this context were critical to complement the use of training and training tools. A summary of the project’s outcomes is provided along with the key challenges identified and the lessons learnt.

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Kajubi, Phoebe, Allison Ruark, Norman Hearst, Sam Ruteikara, and Edward C. Green. "Assessment of an HIV-prevention intervention for couples in peri-urban Uganda: pervasive challenges to relationship quality also challenge intervention effectiveness." African Journal of AIDS Research 19, no. 3 (July 2, 2020): 249–62. http://dx.doi.org/10.2989/16085906.2020.1811357.

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Awokola, Babatunde I., Gabriel Okello, Kevin J. Mortimer, Christopher P. Jewell, Annette Erhart, and Sean Semple. "Measuring Air Quality for Advocacy in Africa (MA3): Feasibility and Practicality of Longitudinal Ambient PM2.5 Measurement Using Low-Cost Sensors." International Journal of Environmental Research and Public Health 17, no. 19 (October 3, 2020): 7243. http://dx.doi.org/10.3390/ijerph17197243.

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Ambient air pollution in urban cities in sub-Saharan Africa (SSA) is an important public health problem with models and limited monitoring data indicating high concentrations of pollutants such as fine particulate matter (PM2.5). On most global air quality index maps, however, information about ambient pollution from SSA is scarce. We evaluated the feasibility and practicality of longitudinal measurements of ambient PM2.5 using low-cost air quality sensors (Purple Air-II-SD) across thirteen locations in seven countries in SSA. Devices were used to gather data over a 30-day period with the aim of assessing the efficiency of its data recovery rate and identifying challenges experienced by users in each location. The median data recovery rate was 94% (range: 72% to 100%). The mean 24 h concentration measured across all sites was 38 µg/m3 with the highest PM2.5 period average concentration of 91 µg/m3 measured in Kampala, Uganda and lowest concentrations of 15 µg/m3 measured in Faraja, The Gambia. Kampala in Uganda and Nnewi in Nigeria recorded the longest periods with concentrations >250 µg/m3. Power outages, SD memory card issues, internet connectivity problems and device safety concerns were important challenges experienced when using Purple Air-II-SD sensors. Despite some operational challenges, this study demonstrated that it is reasonably practicable and feasible to establish a network of low-cost devices to provide data on local PM2.5 concentrations in SSA countries. Such data are crucially needed to raise public, societal and policymaker awareness about air pollution across SSA.

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O’Donovan, James, Rebecca Hamala, Allan Saul Namanda, David Musoke, Charles Ssemugabo, and Niall Winters. "‘We are the people whose opinions don’t matter’. A photovoice study exploring challenges faced by community health workers in Uganda." Global Public Health 15, no. 3 (September 17, 2019): 384–401. http://dx.doi.org/10.1080/17441692.2019.1663233.

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Nuwagaba-Biribonwoha, H., R. T. Mayon-White, P. Okong, and L. M. Carpenter. "Challenges faced by health workers in implementing the prevention of mother-to-child HIV transmission (PMTCT) programme in Uganda." Journal of Public Health 29, no. 3 (July 17, 2007): 269–74. http://dx.doi.org/10.1093/pubmed/fdm025.

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A.B., Aremu, Afolabi I.B, Salaam M. Awunor N.S, Sulayman A.A, Ilori O., Nwanna K.U, and Suubi R. "PREVALENCE AND FACTORS ASSOCIATED WITH ROUTINE MEDICAL CHECKUP AMONG PATIENTS ATTENDING MASAKA REGIONAL REFERRAL HOSPITAL, UGANDA." International Journal of Advanced Research 9, no. 07 (July 31, 2021): 97–105. http://dx.doi.org/10.21474/ijar01/13104.

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Globally, Routine Medical checkup is known to be a preventive medicine that opens doors for assessment of well-being status of all individual and decreases the mortality and morbidity of different ailments in communities. attending health checkups may be one of the key reasons of controlling the predisposition and cause of much of the illness, suffering and early death related to chronic illnesses and condition. Its on this ground that this current study sought to elucidate further on factors determining the adherence of people to medical checkups. A descriptive cross-sectional study was carried out among 385 adult respondents attending Masaka regional referral hospital, in Uganda. A structured questionnaire involving open-ended and close-ended questionnaire was used and data was analyzed using SPSS version 26. Overall, 61.3% of study participants have ever heard of routine health check-ups citing hospitals (25.7%) as the most used source of the information. A prevalence of 43.4% represents the percentage of those who do routine health check-up and of which majority engage in only a general examination (14.5%). Overall, more than half of the respondents (56.6%) have never participated in routine health check-ups with their reported reasons of not feeling sick (25.97%). Factors like level of education, Employment, Occupational, exercise practices and level of awareness was statistically significant to uptake of routine heath checkup among the respondent at P< (0.005). Low health check-up rates may translate into inability to detect and intervene with early health challenges among respondents, and this is whereeffort is needed in ensuring that routine health check-up is encouraged especially during times when patients are healthy. There is need to strengthen government efforts and other concerned NGOs to put across specific sensitization programs about routine health check-ups on different media platforms and also utilize other social public means.

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Mukama, Trasias, Rawlance Ndejjo, David Musoke, Geofrey Musinguzi, Abdullah Ali Halage, David O. Carpenter, and John C. Ssempebwa. "Practices, Concerns, and Willingness to Participate in Solid Waste Management in Two Urban Slums in Central Uganda." Journal of Environmental and Public Health 2016 (2016): 1–7. http://dx.doi.org/10.1155/2016/6830163.

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Poor solid waste management is among the major challenges facing urban slums in developing countries including Uganda. Understanding community concerns and willingness towards involvement in solid waste management improvement initiatives is critical for informing interventions in slums.Methods. We used a cross-sectional study to collect quantitative data from 435 residents in two urban slums in central Uganda. A semistructured questionnaire was used which assessed waste collection practices, separation and disposal methods, concerns regarding solid wastes, and willingness to participate in waste separation and composting. Data was analysed using STATA 12.Results. Food remains (38%) and plastics (37%) formed the biggest proportion of wastes generated in households. Most households (35.9%) disposed of general wastes by open dumping while 27% disposed of plastics by burning. Only 8.8% of households conducted composting while 55% carried out separation for some decomposable wastes. Separation was carried out for only banana peelings and leftover foods for feeding animals. Respondents expressed high willingness to separate (76.6%) and compost (54.9%) solid wastes.Conclusion. Practices in waste disposal and separation were poor despite high willingness to participate in initiatives to improve waste management, highlighting a need for authorities to engage residents of slums to improve their practices.

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Ndejjo, Rawlance, Paineto Masengere, Fred Nuwaha, Isaac Ddumba, Hilde Bastiaens, Rhoda K. Wanyenze, and Geofrey Musinguzi. "Hypertension and diabetes patients’ perspective of challenges and their coping mechanisms in Mukono and Buikwe districts in Uganda – a qualitative study." Open Research Europe 1 (March 26, 2021): 30. http://dx.doi.org/10.12688/openreseurope.13286.1.

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Background: In sub-Saharan Africa, the burden of non-communicable diseases is steadily rising amidst a high prevalence of communicable diseases stretching the healthcare system. This study explored hypertension and diabetes patients’ perspective of challenges and their coping mechanisms in Mukono and Buikwe districts in Uganda. Methods: This descriptive qualitative study involved four focus group discussions with 26 patients at four selected health facilities. All interviews were audio recorded, transcribed verbatim and data analysed following the thematic content analysis guided by the semantic approach with the aid of Atlas ti 6.0.15 software. Results: Five themes were identified regarding challenges and coping mechanisms of patients in managing their conditions. 1) Inadequate opportunities for diagnosis, with community screening supporting identification of patients. 2) Accessing care came amidst transport challenges, absence of health workers and the lack of essential supplies for monitoring conditions. Patients borrowed transport funds or trekked to health facilities and some formed groups to contribute resources to buy equipment and supplies. 3) Access to medications was affected by frequent drug stockouts at public health facilities which pushed patients to purchase own drugs or obtain these through friends and networks. However, other patients resorted to cheaper herbal remedies. 4) Monitoring and managing conditions was affected by insufficient knowledge and opportunities for self-monitoring. Information from health workers and experiences from peers bridged the knowledge gap while private facilities or community health workers supported self-monitoring. 5) Adopting changes in behaviour was challenging but patients fitted these within their usual routines and mobilised family members to also adopt lifestyle changes while ignoring those they deemed unrealistic. Conclusions: The coping mechanisms patients adopted to manage their chronic conditions reflects self-care initiatives at the individual and community levels which could be reinforced and supplemented to better support and empower patients as steps are taken to address existing challenges.

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Opollo, Marc Sam, Tom Charles Otim, Walter Kizito, Pruthu Thekkur, Ajay M. V. Kumar, Freddy Eric Kitutu, Rogers Kisame, and Maria Zolfo. "Infection Prevention and Control at Lira University Hospital, Uganda: More Needs to Be Done." Tropical Medicine and Infectious Disease 6, no. 2 (May 1, 2021): 69. http://dx.doi.org/10.3390/tropicalmed6020069.

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Globally, 5–15% of hospitalized patients acquire infections (often caused by antimicrobial-resistant microbes) due to inadequate infection prevention and control (IPC) measures. We used the World Health Organization’s (WHO) ‘Infection Prevention and Control Assessment Framework’ (IPCAF) tool to assess the IPC compliance at Lira University hospital (LUH), a teaching hospital in Uganda. We also characterized challenges in completing the tool. This was a hospital-based, cross-sectional study conducted in November 2020. The IPC focal person at LUH completed the WHO IPCAF tool. Responses were validated, scored, and interpreted per WHO guidelines. The overall IPC compliance score at LUH was 225/800 (28.5%), implying a basic IPC compliance level. There was no IPC committee, no IPC team, and no budgets. Training was rarely or never conducted. There was no surveillance system and no monitoring/audit of IPC activities. Bed capacity, water, electricity, and disposal of hospital waste were adequate. Disposables and personal protective equipment were not available in appropriate quantities. Major challenges in completing the IPCAF tool were related to the detailed questions requiring repeated consultation with other hospital stakeholders and the long time it took to complete the tool. IPC compliance at LUH was not optimal. The gaps identified need to be addressed urgently.

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Nachega, Jean B., Rhoda Atteh, Chikwe Ihekweazu, Nadia A. Sam-Agudu, Prisca Adejumo, Sabin Nsanzimana, Edson Rwagasore, et al. "Contact Tracing and the COVID-19 Response in Africa: Best Practices, Key Challenges, and Lessons Learned from Nigeria, Rwanda, South Africa, and Uganda." American Journal of Tropical Medicine and Hygiene 104, no. 4 (April 7, 2021): 1179–87. http://dx.doi.org/10.4269/ajtmh.21-0033.

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ABSTRACTMost African countries have recorded relatively lower COVID-19 burdens than Western countries. This has been attributed to early and strong political commitment and robust implementation of public health measures, such as nationwide lockdowns, travel restrictions, face mask wearing, testing, contact tracing, and isolation, along with community education and engagement. Other factors include the younger population age strata and hypothesized but yet-to-be confirmed partially protective cross-immunity from parasitic diseases and/or other circulating coronaviruses. However, the true burden may also be underestimated due to operational and resource issues for COVID-19 case identification and reporting. In this perspective article, we discuss selected best practices and challenges with COVID-19 contact tracing in Nigeria, Rwanda, South Africa, and Uganda. Best practices from these country case studies include sustained, multi-platform public communications; leveraging of technology innovations; applied public health expertise; deployment of community health workers; and robust community engagement. Challenges include an overwhelming workload of contact tracing and case detection for healthcare workers, misinformation and stigma, and poorly sustained adherence to isolation and quarantine. Important lessons learned include the need for decentralization of contact tracing to the lowest geographic levels of surveillance, rigorous use of data and technology to improve decision-making, and sustainment of both community sensitization and political commitment. Further research is needed to understand the role and importance of contact tracing in controlling community transmission dynamics in African countries, including among children. Also, implementation science will be critically needed to evaluate innovative, accessible, and cost-effective digital solutions to accommodate the contact tracing workload.

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Paul, Mandira, Sara B. Näsström, Marie Klingberg-Allvin, Charles Kiggundu, and Elin C. Larsson. "Healthcare providers balancing norms and practice: challenges and opportunities in providing contraceptive counselling to young people in Uganda – a qualitative study." Global Health Action 9, no. 1 (May 11, 2016): 30283. http://dx.doi.org/10.3402/gha.v9.30283.

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Tumwine, Christopher, Peter Aggleton, and Stephen Bell. "Accessing HIV treatment and care services in fishing communities around Lake Victoria in Uganda: mobility and transport challenges." African Journal of AIDS Research 18, no. 3 (September 27, 2019): 205–14. http://dx.doi.org/10.2989/16085906.2019.1648306.

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Adebisi, Yusuff Adebayo, Adrian Rabe, and Don Eliseo Lucero-Prisno III. "Risk communication and community engagement strategies for COVID-19 in 13 African countries." Health Promotion Perspectives 11, no. 2 (May 19, 2021): 137–47. http://dx.doi.org/10.34172/hpp.2021.18.

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Background: Coronavirus disease 2019 (COVID-19) outbreak is a major threat facing health systems globally and African countries are not an exception. Stakeholders, governments, and national authorities have mounted responses to contain the pandemic. This study aimed to catalogue the risk communication and community engagement (RCCE) strategies as well as the challenges facing RCCE in 13 African countries. Methods: We conducted a narrative review of evidence to answer the aim of the study. The search was conducted in March 2021 and evidence published between December 2019 and February 2021 were included. Data reported in this article were obtained from reports, literature in peer-reviewed journals, grey literature and other data sources in 13 African countries. The 13 countries include Ethiopia, Ghana, Kenya, Algeria, Angola, Cote d’Ivoire, the Democratic Republic of the Congo, Mauritius, Nigeria, South Africa, Tanzania, Uganda, and Zambia. The authors also snowball further data to gather information for this review. Results: Most of the priority African countries have RCCE strategies to contain the transmission and spread of the coronavirus. Our findings revealed RCCE strategies in the 13 African countries focused on training and capacity building, risk communication systems, internal and partners’ coordination, community engagement, public communication, contending uncertainty, addressing misperceptions and managing misinformation. However, the RCCE response activities were not without challenges, which included distrust in government, cultural, social, and religious resistance, and inertia among others. Conclusion: With the similar RCCE approaches and interventions seen across the countries, it is clear that countries are learning from each other and from global health organizations to develop COVID-19 RCCE programs. It is important for African countries to address the challenges facing RCCE in order to effectively contain the pandemic and to prepare for future public health emergencies.

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Kyarimpa, A. "Delivering Cost-Effective Cervical Cancer Screening Package to Women Living With Human Immunodeficiency Virus By Reproductive Health Uganda." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 146s. http://dx.doi.org/10.1200/jgo.18.77200.

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Background and context: Uganda has one of the highest cervical cancer incidences in the world. Over 80% late diagnosis compounds the challenge. It is evident that women living with human immunodeficiency virus (HIV) have a higher prevalence of precancer lesions and have limited access to cervical cancer knowledge and relevant services especially women living with HIV, who are poor and marginalized. This results in a gap for first-line defense to cervical cancer. To bridge the gap and deliver services, Reproductive Health Uganda (RHU) introduced cost-effective “see and treat”, single visit approach (SVA), using combined visual inspection with acetic acid (VIA) and cryotherapy. Aim: To promote single visit approach in cervical cancer screening program in selected HIV clinics and assess the feasibility. Strategy: • Collaborate with HIV clinics, which enroll and provide counseling and services to women living with HIV • Integrate SVA into the current services package in HIV clinics and outreaches to break geographic barriers • Train RHU and public health clinic staff to perform VIA and cryotherapy if needed • Enable SVA in public antiretroviral therapy (ART) clinics through partnerships • Awareness creation through group health education and individual counseling Program: The project implemented in three high HIV prevalence rate districts targeted women 25-49 years of age. Partnered with public ART clinics and arranged training to ensure midwives and nurses in RHU and public health facilities are able to carry out VIA and cryotherapy if needed. Announcements and appointment posters were pinned up on the facility notice board providing details of dates and service package. RHU used this opportunity to promote contraception and STIs management. Health education and counseling session were conducted. Trained peer support mothers mobilized women seek cervical cancer screening when doing HIV follow-up. Quarterly support supervision, QOC assessments and DQAs were conducted to ensure quality and reliability of results and reports. Outcomes: Acceptability of cervical cancer screening was high. The project increased general awareness among rural community members, where cancer is generally stigmatized and associated with a lot of myths. Knowledge, skills and competencies of 54 midwives to screen for and treat with cryotherapy was built. 23,713 women were screened, with average VIA positivity rate 8%-11% across project districts. 98% of cryotherapy-eligible women treated during the same visit. Referral to Ugandan cancer institute was established to ensure timely cancer therapy. Integration and acceptability of family planning increased among women attending ART clinics. What was learned: With appropriate demand creation, acceptability of SVA was good among women attending the ART clinics, SVA is cost-effective and feasible. Integration of SRH package of services helps leverage resources. Strategic partnerships are critical in strengthening public–private partnership in services provision.

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Nanyonga, Rose Clarke, Edna N. Bosire, David J. Heller, Elizabeth Bradley, and Nancy R. Reynolds. "Predictors of nursing leadership in Uganda: a cross-sectional study." Health Policy and Planning 35, Supplement_1 (November 1, 2020): i51—i64. http://dx.doi.org/10.1093/heapol/czaa100.

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Abstract Evidence regarding the role of nurses-in-leadership and how to engage nurses in policy decisions is minimal in sub-Saharan Africa. The purpose of this study was: (1) to assess the leadership practices of nurses-in-leadership in Uganda (by self-report) and from the perspective of ‘followers’ (direct-report, peers, co-workers, other); and (2) to determine factors (positively) associated with leadership practices. We surveyed 480 nurses, 120 in leadership roles (Response Rate 57%) and 360 ‘followers’ (Response Rate 60%), who were recruited from five hospitals in Kampala, Uganda. We used the Leadership Practice Inventory (Self and Observer), a project-specific demographic questionnaire and Denison’s Organizational Culture Survey (DOCS). Sixty-three per cent of the respondents held a registered nursing certificate; 79% had received formal leadership training; 47% were based in private for-profit (PFP) hospitals, 28% in private not-for-profit (PNFP) and 25% in public hospitals. Among the five leadership practices, nurses-in-leadership used the practice of Model the Way (M = 8.27, SD = 1.30), Challenge the Process (M = 8.12, SD = 1.30) and Encourage the Heart (M = 8.04, SD = 1.51) more frequently (on a 10-point Likert Scale). Inspire a Shared Vision (M = 7.82, SD = 1.57) and Enable Others to Act (M = 7.62, SD = 1.66) practices were used less frequently. The same rank order was true for leadership scores from the perception of followers. However, leadership scores by followers were significantly lower (P < 0.01) than the nurse leader self-reported scores across all sub-scales. Leadership practice scores were higher in public than private hospitals (P < 0.0001). Organizational culture (OC) was associated (P < 0.001) with leadership practices. Although overall leadership practice scores were generally high, the less frequent use of Inspire and Enable practices suggests opportunities for targeted improvement. Moreover, differences between self-reported and leadership scores by followers suggest perception gaps between leaders and their followers. The positive relationship between public hospital settings and self-reported leadership practices among nurses-in-leadership suggests that important nursing leadership practices are possible even in a low-resource clinical setting.

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Lifshay, Julie, Sylvia Nakayiwa, Rachel King, Olga Grinstead Reznick, David Katuntu, Richard Batamwita, Enoch Ezati, Alex Coutinho, Cissy Kazibwe, and Rebecca Bunnell. "Partners at risk: motivations, strategies, and challenges to HIV transmission risk reduction among HIV-infected men and women in Uganda." AIDS Care 21, no. 6 (June 2009): 715–24. http://dx.doi.org/10.1080/09540120802511844.

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M Nanteza, Barbara, Ronald H Gray, David Serwadda, C. Kennedy, and Fredrick Makumbi. "VMMC clients’ perception of increased risk of HIV infection, circumcision preferred choice of method, providers’ socio-demographics and mode of service delivery." African Health Sciences 20, no. 4 (December 16, 2020): 1562–72. http://dx.doi.org/10.4314/ahs.v20i4.8.

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Introduction: Voluntary medical male circumcision (VMMC) is a scientifically proven HIV prevention intervention. Uganda, like many countries has been implementing VMMC for over 10 years but uptake is still low especially in northern Uganda. To attain 80% needed for public health impact, scale-up was recommended with many innovations implemented with sub-optimal results. This study therefore wanted to find out some of the correlates of VMMC uptake in Gulu district, northern Uganda. Methods: Two studies were conducted separately but data was analyzed for this study. For the quantitative study, propor- tions and frequencies were used to measure perception of increased risk of HIV infection using age, gender, occupation, marital and circumcision status. Qualitative study provided data from FGDs, IDIs and KIIs were first transcribed in Acholi and then translated in English. Transcripts were uploaded in MAXDQA software for data management. A code book for emerging themes was developed. Results: A total of 548 respondents were interviewed for the quantitative study, where two thirds (66%) of the participants perceived themselves to be at increased risk of HIV infection. For the qualitative study, 149 participants from 19 FGDs, 11 KIIs and 9 IDIs were interviewed. Data were analyzed thematically using both inductive and deductive approaches. Devices were preferred to conventional surgery while mobile services were preferred to static services. However, there were diver- gent views regarding circumcision service providers’ socio-demographics and these were influenced mainly by age, level of education and location. Conclusion: People in Northern Uganda perceived themselves to be at an increased risk of HIV infection. They preferred devices to conventional surgery, mobile services to static services but had varying views about the socio-demographics of the service providers. Keywords: Male circumcision; challenges; HIV prevention.

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Sakomoto, Takuya, Mahmood Lutaaya, and Edo Abraham. "Managing Water Quality in Intermittent Supply Systems: The Case of Mukono Town, Uganda." Water 12, no. 3 (March 13, 2020): 806. http://dx.doi.org/10.3390/w12030806.

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Intermittent water supply networks risk microbial and chemical contamination through multiple mechanisms. In particular, in the cities of developing countries, where intrusion through leaky pipes are more prevalent and the sanitation systems coverage is low, contaminated water can be a public health hazard. Although countries using intermittent water supply systems aim to change to continuous water supply systems—for example, Kampala city is targeting to change to continuous water supply by 2025 through an expansion and rehabilitation of the pipe infrastructure—it is unlikely that this transition will happen soon because of rapid urbanisation and economic feasibility challenges. Therefore, water utilities need to find ways to supply safe drinking water using existing systems until gradually changing to a continuous supply system. This study describes solutions for improving water quality in Mukono town in Uganda through a combination of water quality monitoring (e.g., identifying potential intrusion hotspots into the pipeline using field measurements) and interventions (e.g., booster chlorination). In addition to measuring and analyses of multiple chemical and microbial water quality parameters, we used EPANET 2.0 to simulate the water quality dynamics in the transport pipeline to assess the impact of interventions.

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Nsonga, Joseph, John Paul Dongo, Frank Mugabe, Gerald Mutungi, Richard Walyomo, Christopher Oundo, Sarah Zalwango, et al. "Screening tuberculosis patients for diabetes mellitus in a routine program setting in Kampala, Uganda: a cross-sectional study." F1000Research 8 (June 17, 2019): 872. http://dx.doi.org/10.12688/f1000research.19279.1.

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Background: Uganda is located in East Africa and is among the countries with the lowest income globally. The ten health centres in this project serve populations in the under-privileged communities of Kampala. The objective of the study was to implement diabetes mellitus (DM) screening among tuberculosis (TB) patients in a routine program setting with limited resources and high human immunodeficiency virus (HIV) prevalence. Methods: A descriptive cross-sectional observational study was conducted in ten health centres in Kampala, Uganda. As part of a project to implement DM screening in a routine setting, TB patients were screened for DM by trained health workers. A fasting blood glucose (FBG) value ≥7.0mmol/l was considered to indicate DM. For this study, aggregate data was collected and analysed using SPSS for Windows, version 13.0. Results: Among 4,590 TB patients registered, 4,016 (88.0%) were screened with random blood glucose (RBG). Of those with RBG ≥6.1mmol/l, 1,093 (83.3%) were screened with FBG. In total, 92 (2.3%) patients were diagnosed with DM and 66 (71.8%) of them were newly diagnosed. The proportion of TB patients screened with FBG in the health centres varied from 58.2% to 100%. The proportion of patients screened with FBG and the prevalence of DM were significantly higher in private health centres compared with public health centres. The health centres in peri-urban areas screened more patients with RBG than those in urban areas. Health centres without DM services screened a larger number of patients with RBG and FBG than those with DM services. Conclusions: It appears feasible to implement screening TB patients for DM in routine program settings with limited resources and high HIV prevalence. Its introduction requires close collaboration between TB and DM services. The challenges identified need government attention and certain institutional and service-related factors need to be better managed at times.

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Journal articles on the topic 'Public health, Challenges, Uganda'

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